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Tricare Denial..REVERSED!!



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Hi Tomatogirl, The weather is also a lot better in FL, rather than MD. Do we have to get an authorization for fills from Tricare? I'm still not feeling hungry, and hope it stays that way. How about the rest of you? Maggies:shades_smile:

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I'm so excited bout missing most (if not all) of winter that I could wet myself. I grew up in lower Alabama- I had never seen actual standing snow until we moved here a little over a year ago and I HATE THE STUFF.

The way it was explained to me is that you should have a referral to your doctor for ___ visits until ___insert date here___ (mine is through February. Once those are used up, you can either call Tricare and ask for more visits (usually they give them without much hassle) or go to your PCP and ask for more referrals to your surgeon.

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Oh and I'm not hungry either, but I've been dying for sweets today. I finally broke down and had 1/4 cup of sugar free/fat free ice cream. Not too horrible, and it actually had a bit of Protein in it!

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The problem is my surgeons office do not do fills. They refer you to the hospital where the surgery was done. I wonder if that would be covered. I might call Tricare after my post op appt. tomorrow. I am not coming home until Saturday or Sunday. Going to visit with my son and grandson.

Maggies:shades_smile:

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Isn't it nice? I like getting on the scales now. The last couple of days I have been doing lots of cardio and weight lifting and the weight loss has slowed down. I think maybe it is just my muscles...they are sore and I know that I will hold Fluid at this stage. I got my first adjustment and she said that I may not be able to tell a difference. Well, I am still on mushies...today I ate a veggie medley and took 3 bites and I am full. That is my first solid food. I am scared to get stuck!

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Hi, Congratulations on the great weight loss Tomatogirl. I will weigh myself again on Tuesday to see where I am. I'm sure I'm no where close to 17lbs. I wish!!!! I found out I have a 14 cc band, with 3cc put in at time of surgery.

JWRN, When are you starting meats and such? At your stage I should already be on them if I can tolerate them. It is a great feeling to know that when I get on the scale there will be a loss and not a gain.. I still have a love/hate relationship with the scale. Keep up the good losing.

Maggies:shades_smile:

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I am going to start meats today or tomorrow. I have been eating shaved turkey and ham, which is on the mushy diet.

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JWRN, How did the regular diet go? I don't seem to get hungry, but I can drink as much Water as I want with no problems. Could all of you? So it makes me question if it is going to be the same way with food. I hope not. Maggie:shades_smile:

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I bought some turkey and veggie burgers and had a turkey burger with ff cheese. I ate about 3/4 of it before I was full. No issues. I don't drink Fluid for a half and hour after. So far so good. Sad thing is, my little cocker spaniels are going to get fat eating all of my leftovers (well, they are low fat foods, that should help!)

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JWRN, you are doing great, wow, 52lbs. already Congratulations. I only lost 2bls. this week, and I have only ate/drank exactly what I'm suppossed to. I hope I'm not going to be a slow loser. But at least it went down, and not up or the same. Keep up the great work. Maggie:shades_smile:

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Hi- Maggies, JWRN

Congrats on all your sucess! I have been watching your posts for a little over a month you have been very informative. I have tricare prime and it took six months to get a referral from my PCM. I have an appt with the surgeon on Wednesday. The last few times I went in my BP was 142/84 and then 140/80. My PCM told me its normal not to worry. I had my Gallbladder removed about six years ago due to gallstones. I am just at the 100lb mark and I'm trying not to get my hopes up. I dont have any other severe co morbidities ( I've not had a sleep study done ) Im sure my cholestrol is high but I was wondering since you two have been through this and given out a lot of advice. What do you think the chances are of getting approved?

Thanks

Ashley:unsure:

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First of all, if you have to wait that long to get a PCM approval, I would go to someone else. I went in to a doctor I had never met before, handed them a paper that I typed up (a typed health history, diet history, etc) and said "I want a referral for lapband sugery". I don't know if it was because I was a nurse, but he didn't hesitate and wrote the referral. There are stories here of people getting approved without the comorbidities...but I think Tricare is getting a little tougher. You will HAVE to follow thier guidelines. You have to have a comorbidity if fall in the 100 lbs category. If you are 200% overweight you should have no problem.

Have you been on blood pressure meds? Do you have painful joints? Etc Etc.

Just try to be prepared. I really can't believe Karina got denied again after all she went through. I think part of it depends on who reviews your paperwork at Tricare.

Good luck!

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Welcome Ashley, I agree 100% with JWRN. If I were you I would get a sleep study done. Without it I would not have been approved. I had no idea I had sleep apnea. I knew I would wake up every hour or two all nite long, but didn't know it was because I was stopping breathing. And also make sure you are at least 101lbs. overweight. Like JWRN said I believe it is getting harder to get approved for lapband or gastric bypass with Tricare, but if you fit into their criteria they can't deny you. Good luck and let us know how it goes.

Hi JWRN, Hows things going with you? I am so looking forward to getting back to regular foods. I started mushies today and had some white Beans which I added a little bit of Tomato juice to. They were great.... Have a good weekend

Maggies:shades_smile:

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I am doing great. I am down to 178 lbs. Can't believe it! Boobies are sagging though :Dancing_sorry:

I have introduced regular food this week and it has been going good. Of course, I am not over doing it. No bread, rice or Pasta. Last night at work I was hungry, so I invaded the doctor's lounge (I supervise sometimes and have access to the whole hospital). I had a boiled egg and 3 cubes of cheese. It was tempting not to get a bear claw, but I resisted. I really don't feel much restriction, so I am really trying to be good.

I am very happy with the band...so far no regrets!

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